Why all govs will opt into ‘Obamacare’

By Jennifer Granholm, POLITICO

Southern govs to secede from health care?

Right. Just like they have from Medicaid expansion. Good luck with that.

If you can hear yourself think over the sound of Texas Gov. Rick Perry’s chest-thumping, here’s something to consider: All this talk about governors opting out of Medicaid expansion in “Obamacare” is startlingly similar to what happened when Medicaid was launched in 1966.

Back then, the states could choose to opt in, just as today under “Obamacare.” At first, only six states signed up for Medicaid — with a lot of fear of putting state money into a new program. But within a few years, every single state had opted in — and under Medicaid, the reimbursement rate to the states is only about 50 percent. For the next three years under “Obamacare,” it’s 100 percent.

My prediction: All these states will opt in. Every one. Maybe not before the election, but very soon — notwithstanding the nonsense being spewed today by Perry and the other Republican governors who feel compelled to dance for the tea party. Regardless of Wednesday’s utterly meaningless vote in the House. (Thirty-three times? Really? As though the first 32 times weren’t enough.)

Why will these governors opt in when their rhetoric is so hot? Because the campaign against them will rest on three arguments that would detonate their reelection chances.

Let’s use Perry as an example since he’s threatening to mess with Texas.

Here’s the usual argument about why Texas — or other secessionist states — should opt in, and it’s a good one: Texas has 6 million uninsured citizens — nearly one in four people does not have health care, the highest in the nation. An estimated 2 million would be covered by the exchanges Perry refuses to implement, and another 2 million would qualify for expanded Medicaid. Texas would see the biggest drop in the nation of nonelderly uninsured people.

Instead, Perry would rather be able to chant, “We’re No. 1!” for citizens without health care. How proud y’all must be.

For the tea party crowd, instead of this being a huge missed opportunity to provide health care to struggling people, turning down the federal money has become a badge of honor. So, weirdly, this argument, while appealing to most rational people, has no sway with tea partiers.

By the way, those uninsured citizens are every Texan’s problem. Uninsured people get sick, too, and their care has to be paid for by someone. And you can be sure it will be. It will add an estimated $1,800 a year to family premiums in Texas through the “hidden tax” of uncompensated care. So employers and those with insurance will just pick up the tab for Perry’s itch to drink tea and play politics.

But the ultimate price tag to Texans is far higher: Turning down the Medicaid expansion would mean rejecting $76.3 billion in federal help for 2014-2019. But Texans will still be paying billions in federal taxes to pay for the rest of the country’s Medicaid costs — payroll deductions don’t go away if a state opts out of “Obamacare.”

Does Perry really want to tell Texans that they will be getting nothing back from their weekly Medicaid tax payments? Seems to me those would be fighting words in Texas. It’d essentially be a gift from Texans to the “Obamacare” beneficiaries in, say, New York. Texans funding health care for Yankees! I can just see the campaign commercials now.

Second, the hospital associations in those secessionist states must be going nuts right about now. In order to fund “Obamacare,” the money for hospitals, otherwise known as Disproportionate Share Hospitals, for uncompensated care is going away in all states.

It was part of the grand bargain when “Obamacare” was adopted: Health reform will pay for your uninsured so your special federal funds for uncompensated care will go away. Texas, for example, received nearly $1 billion in DSH funds in 2011 and $1.7 billion the year before.

Every governor tries to have a good relationship with their state hospitals — but opting out of “Obamacare” will cause an irreparable breach. It will be “catastrophic” for hospitals, according to Dr. Bruce Siegel, chief executive officer of the National Association of Public Hospitals and Health Systems.

If a state opts out, the hospitals would lose both DSH funds and reimbursements from “Obamacare” for the newly insured. Hospitals in those states would be forced to either pass along the costs, cut services, go to the state taxpayers or even go bankrupt and close their doors, Siegel said. Never mind that Texas happens to have more award-winning hospitals than any state in the country — five of the best teaching hospitals in the nation.

You remember: Where did former Rep. Gabby Giffords go when she wanted the highest-quality health care for her brain injury? To the acclaimed Memorial Hermann-Texas Medical Center in Houston. Of course, Perry wants the hospitals to just stop their whining and get in line.

Bootstraps, people! Liberty! Freedom!

Oh, and to the 2,955 people who die prematurely each year in Texas because they lack health care? To the families that will lose their loved ones in the name of the ideology that serves only the mega wealthy? You are free, too — free to move to another state that has compassion for its people; to a state that wants to see you live a healthy, productive life; and that gives you the opportunity to pursue the happiness that comes with peace of mind and well-being.

Bring your businesses and business ideas with you. The rest of the states will join the civilized world by offering our people health care, and Texas can do whatever it is they are going to do.

In fact, Gov. Perry, if you opt out of health care for millions of Texans, you won’t have to secede from the Union. Instead, I reckon, come next election, Texans will decide to secede from you.